摘要:

This article examines the use of mental health services in three insurance plans: Blue Cross (BC), a health maintenance organization (HMO), and an independent practice association (IPA) in which the primary care physician was to manage all care for an individual. Approximately 7.3% of the enrollees in all three plans used some mental health care in the 18-month study period. The percent of enrollees with mental health utilization was lower in BC than in the other two plans, but the total quantity of mental health care use per enrollee and per user was much higher in BC than in the HMO and the IPA. Use was highest in the 19-44-year-old age group, and there were no significant differences between men and women in use of mental health services. There were substantial differences by race in all three plans: white persons were more likely to use any mental health care and had more visits than nonwhite persons after seeking mental health use. A similar study was conducted in the early 1970s on a poverty-level population enrolled in BC and die HMO. The findings of this study are similar, except that in the low-income study mental health care use was lower, and males used-less mental health care than females. These differences might be attributable to the difference in enrollees' socioeconomic status in the two studies or to the increasing acceptability of mental health care utilization, particularly formales.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Analysis of national survey data on physician-patient encounters raises questions about physician education and manpower policy. Data compiled by the University of Southern California Medical Activities and Manpower Projects and the United States Bureau of Health Professionals reveal differences among internists, cardiologists, family practitioners, and pediatricians in procedures used for diagnosing and treating several frequently encountered conditions. Differences are observed in expenditure of time and use of a broad range of diagnostic and therapeutic techniques. These differences remain significant even after several important characteristics of individual physicians, patients, and the practice environment have been controlled. Findings from this study underscore the necessity of reviewing the content of medical education and policies that encourage a broad range of specialists to provide primary care. The findings also emphasize the need to address the physician's knowledge base in promoting changes in practice patterns.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This article reports on adopting Gustafson's multiattribute utility method to develop a specific momentary severity index (vis-à-vis severity over time) for nontraumatic chest pain patients. A panel of physicians identified an appropriate set of indicators for the index. Three mathematic models were generated on the basis of these indicators with each model predicting no less than 81% of the variance in overall scores of 96 simulated patients with chest pain. High interrater reliability (0.94) was demonstrated. Congruent validity coefficients between the three model scores and the overall scores vary between 0.71 and 0.92 depending on how the panel physicians are grouped. Results indicate the feasibility of simulating physician judgments regarding patient severity in chest-pain-related cases.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This study explored variation in the decisions of primary care physicians to refer or not to refer obese patients to an endocrinologist and the principles underlying their decisions. Forty-five physicians—family practitioners, obstetricians, and general internists—made referral judgments on 24 cases and completed a questionnaire. Data indicated a difference among specialties in the number of cases referred (P≤ 0.01) that was not accounted for by physician characteristics. The number of cases referred ranged from 0 to 19, with a mean of 8. The patient's desire for treatment by an endocrinologist was overwhelmingly the major factor in decisions to refer. Gynecologists differed from other physicians by referring for management and not expecting the patient to return to their care. Referrals were not made primarily to rule out suspected endocrine disease or out of concern for morbidity due to obesity. These referrals are thus not perceived as medically beneficial, but are responses to patient pressure or physicians' desire to transfer management.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The accurate measurement of physician job satisfaction in organized practice settings is important for both policy and administrative purposes. Previous efforts to measure physician job satisfaction have been unsatisfactory because of either conceptual or methodologic weaknesses. New measures of physician job satisfaction were developed and field tested on a population of physicians working in highly bureaucratic settings—prison health programs across the United States. Analysis of the measures demonstrated their reliability, validity, and ability to predict physicians' intentions to leave the job. The measures can serve to identify elements of the work setting that need to be changed to improve physician job satisfaction.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A simple model was used to calculate the contribution of urinary incontinence (UI) to the costs of nursing home care. First-order costs are defined as the costs of managing UI: supplies, laundry, and labor. Second-order costs are defined as the costs of managing the complications of UI. Data were gathered from nursing homes, medical supply companies, and a large laundry company. First-order costs of four common methods of managing UI range between $3.00 and $11.00 per incontinent patient per day. Based on these estimates, UI accounts for between $0.5 and $1.5 billion (3-8%) of the costs of nursing home care. Management of UI with indwelling catheters results in the lowest firstorder costs, but the second-order costs (as well as the potential increased morbidity and mortality risks) probably outweigh any cost savings. More active evaluation and treatment of UI in nursing homes could result in considerable cost savings and improved well-being for both patients and caregivers.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The announcement that orders for long-term electrocardiograms were the subject of study in a community hospital was followed by a decrease in ordering rate of 30% from the corresponding quarter in the previous year. In succeeding quarters the decrement from corresponding quarters in the prior year was 21%, 27%, and 6%. Thereafter the ordering rate began to increase at a rate of 75% per year. In another community hospital in a contiguous town in which no surveillance was undertaken, the ordering rate for long-term electrocardiogram grew persistently at the rate of 42% per year over the same 3-year interval. The cardiologists at the community hospital under study behaved no differently as a group than other physicians in the community. The data strongly suggest that announced surveillance had the effect of diminishing long-term electrocardiogram tests ordered by community physicians by at least 20% for a period that lasts up to 9 months.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

If competition proposals are to reduce the cost of medical care, they must put forth a key role for physicians. Inasmuch as most proposals focus on the market for health insurance, the means by which policies that affect insurers are transmitted to influence the behavior of physicians are largely unknown. A larger role for competing groups of physicians is hypothesized, but the effect of competition is likely to be uneven, because group practice physicians are already in the most competitive areas of the country in terms of the density of physicians, and very few are in rural areas or in other particular regions of the country. Little evidence can be found in productivity or fee level differences between solo and group practice physicians. Thus the value of promoting group medical practices rests on their ability to reduce the use of expensive medical care. It is possible that competition proposals may not hold much promise for reducing costs. Nevertheless, they may still be worthwhile if they are better able than the present system to translate the wishes of consumers into the services of providers.

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1984

数据来源: OVID